A retrospective review of all serial transverse enteroplasty (STEP) procedures from Omaha provides more data on long-term outcomes (J Pediatr 2014; 164: 93-8).  In total 51 patients underwent a total of 68 STEP procedures.  Underlying bowel diseases: NEC (n=8), Gastroschisis (n=29), Intestinal Atresia (n=11), and Volvulus (n=4).  Median length prior to STEP: 30 cm.

Results:

• Median bowel length gain of 54% (median 51 cm) was noted with first STEP.
• Median age of 1 year at first STEP
• Parenteral caloire requirement decreased to median <20 kcal/kg/day at 1 year post-op
• Longer length gains had higher risk of stricture formation.  Six strictures developed which occurred in the first 22 procedures in the series.  Subsequently, the authors state that they have not reduced the luminal diameter below 2 cm at any point.
• 7 children underwent transplantation; 60% of non-transplanted children were enterally independent.  The authors note that “no child has gone on to transplant following a STEP procedure since August 2009.”
• 48 of 51 children are alive at a median of 39 months of followup.

Bottomline: The authors philosophy is that the STEP should create uniformity of luminal diameter as the first priority rather than increased length.  Based on their experience, there appears to be a learning curve to optimizing outcomes with STEP procedures.

Also noted: J Pediatr 2013; 163: 1692-6.  Retrospective study of prospectively collected data from 178 children with regard to micronutrient deficiency among intestinal failure patients transitioning to enteral feeds. Figures 1 and 2 along with Table 2 provide the prevalence of micronutrient deficiency while receiving supplemental parenteral nutrition (PN) and while on full enteral nutrition (FEN).  Iron deficiency was most common in both situations with prevalence of 84% and 61% respectively. With the exception of folate (0%), all of the vitamins and micronutrients had fairly high rates of deficiency.  While on FEN defiencies were  the following:

• Vitamin A 19%
• Vitamin B12 6.5%
• Vitamin D 30%
• Vitamin E 6%
• Copper 8%
• Iron 61%
• Selenium 4%
• Zinc 23%

A recent post on The Pediatric Nutritionist blog provides a suggested approach to the monitoring of vitamins and micronutrients based on the need for parenteral nutrition and on the need to consider inflammatory markers in the interpretation of these lab values: The Importance of Nutrition Lab Monitoring Protocols Featuring …

Related blog entries:

• OUTCOMES WITH STEP PROCEDURE | GUTSANDGROWTH
• FOUR ADVANCES FOR INTESTINAL FAILURE | GUTSANDGROWTH
• IFFY OUTCOME | GUTSANDGROWTH
• Rehabilitation for Short Bowel Syndrome | gutsandgrowth  –this post relates the same centers experience with 20 ultra-short bowel syndrome patients.